Participation in Treatment and Alcoholics Anonymous

So keep taking the medicine…

“A 16-Year Follow-Up of Initially Untreated Individuals

Abstract

This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 16-year outcomes. Subsequent AA involvement was also associated with better 16-year outcome…some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA.

We focus here on participation in professional treatment and AA among previously untreated individuals after these individuals initially sought help for their alcohol use disorders and address three sets of questions:

  1. Is the duration of treatment obtained in the first year after seeking help, and the duration of subsequent treatment, associated with individuals’ long-term (16-year) alcohol-related and psychosocial outcomes? Is participation in treatment in the second and third years … after initiating help seeking associated with additional benefits beyond those obtained from participation in the first year?
  2. Is the duration of participation in AA in the first year, and the duration of subsequent participation, associated with individuals’ long-term (16-year) outcomes? Is participation in AA in the second and third years associated with additional benefits beyond those obtained from participation in the first year?
  3. Many of the individuals who participate in one modality of help (professional treatment or AA) also participate in the other modality. Accordingly, we focus on whether the associations between the duration of participation in treatment and AA and 16-year outcomes are independent of participation in the other modality of help. We also consider interactions between the duration of treatment and AA in that, for example, one modality could compensate for or amplify the influence of the other.

 

Independent Contribution of Treatment and Alcoholics Anonymous

Patients who participate in both self-help groups and treatment tend to have better outcomes than do patients who are involved only in treatment (Fiorentine, 1999;Fiorentine & Hillhouse, 2000). According to Moos et al. (2001), patients with substance use disorders who attended more self-help group meetings had better 1-year outcomes.

Similarly, among patients discharged from intensive substance use care, participation in self-help groups was associated with better 1-year (Ouimette et al., 1998), 2-year, and 5-year (Ritsher, Moos, & Finney, 2002; Ritsher, McKellar, et al., 2002) outcomes, after controlling for outpatient mental health care. We focus here on whether the duration of participation in one modality of help (treatment or AA) contributes to long-term outcomes beyond the contribution of participation in the other modality.

Prior Findings With This Sample

In prior work with the current sample, we found that individuals who entered treatment or AA in the first year after seeking help had better alcohol-related outcomes and were more likely to be remitted (in recovery) than were individuals who did not obtain any help. Individuals who participated in treatment and/or in AA for a longer interval in the first year were more likely to be abstinent and had fewer drinking problems at 1-year and 8-year follow-ups (Moos & Moos, 2003; 2004a; 2005b; Timko, Moos, Finney, & Lesar, 2000).

In this article, the distinctive focus is on associations between the duration of participation in treatment and AA and 16-year outcomes. We also consider the independent contribution of participation in treatment and AA to 16-year outcomes.

Discussion

Compared to individuals who did not enter treatment in the first year after they sought help, individuals who obtained treatment for 27 weeks or more experienced better 16-year alcohol-related outcomes. Individuals who participated in AA for 27 weeks or more in the first year, and in years 2 and 3, had better 16-year outcomes than did individuals who did not participate in AA. Some of the contribution of treatment reflected participation in AA, whereas the contribution of AA was essentially independent of the contribution of treatment.

Participation in Treatment and 16-Year Outcomes

About 60% of individuals who sought help for their alcohol use problems entered professional treatment within one year. These individuals obtained an average of 20 weeks of treatment. Compared to untreated individuals, individuals who obtained 27 weeks or more of treatment in the first year were more likely to be abstinent and less likely to have drinking problems at 16 years than were individuals who remained untreated. These findings extend earlier results on this sample (Moos & Moos, 2003; 2005b; Timko et al., 1999) and are consistent with prior studies that have shown an association between more-extended treatment and better substance use outcomes (Moos et al., 2000, 2001;Ouimette et al., 1998).

Participation in Alcoholics Anonymous and 16-Year Outcomes

The findings extend earlier results on this sample (Moos & Moos, 2004a; 2005b) and those of prior studies (Connors et al., 2001; Fiorentine, 1999; Ouimette et al., 1998;Watson et al., 1997) by showing that more extended participation in AA is associated with better alcohol-related and self-efficacy outcomes. The results support the benefit of extended engagement in AA, in that a longer duration of participation in the first year, and in the second and third years, was independently associated with better 16-year outcomes. In addition, our findings indicate that attendance for more than 52 weeks in a 5-year interval may be associated with a higher likelihood of abstinence than attendance of up to 52 weeks.

 Part of the association between AA attendance and better social functioning, which reflects the composition of the social network, is likely a direct function of participation in AA. In fact, for some individuals, involvement with a circle of abstinent friends may reflect a turning point that enables them to address their problems, build their coping skills, and establish more supportive social resources (Humphreys, 2004; Humphreys, Mankowski, Moos, & Finney, 1999). Participation in a mutual support group may enhance and amplify these changes in life context and coping to promote better long-term outcomes.

Independent Contribution of Treatment and Alcoholics Anonymous

Consistent with prior studies (Fiorentine, 1999; Fiorentine & Hillhouse, 2000; Moos et al., 2001; Ritsher, McKellar, et al., 2002; Ritsher, Moos, & Finney, 2002), longer participation in AA made a positive contribution to alcohol-related, self-efficacy, and social functioning outcomes, over and above the contribution of treatment.

An initial episode of professional treatment may have a beneficial influence on alcohol-related functioning; however, continued participation in a community-based self-help program, such as AA, appears to be a more important determinant of long-term outcomes.

Moreover, compared with individuals who participated only in treatment in the first year, individuals who participated in both treatment and AA were more likely to achieve 16-year remission (i.e. still be in recovery) (Moos & Moos, 2005a).

In interpreting these findings, it is important to remember that participation in treatment likely motivated some individuals to enter AA; thus, some of the contribution of AA to 16-year outcomes should be credited to treatment. Another consideration involves the differential selection processes into treatment versus AA. Individuals with more severe alcohol-related problems tend to obtain longer episodes of treatment, but this selection and allocation process is much less evident for AA.

These divergent selection processes may help to explain the finding that AA is more strongly associated with positive long-term outcomes than is treatment.”

…keep making the meetings!

References

Moos, R. H., & Moos, B. S. (2006). Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals. Journal of Clinical Psychology, 62(6), 735–750. doi:10.1002/jclp.20259

 

A Message of Hope at Christmas – We Do Recover!!

I have heard various statistics about rates of recovery of the years, especially in AA. Some of the figures were depressing low and often go unchallenged which can be demotivating for those seeking recovery.

Why AAs in particular spread distorted statistics which suggest hardly any one recovers is open to question?

Out of all the people I know who were in treatment before me and in the group after me, as well as with me and who completed the entire course of treatment most of them, i.e. a high majority of at least 3/4s, are still in recovery.

This suggests to me that those who seek treatment, whether 12 step based treatment or via taking the steps, with fearlessness and honesty, do actually recover long term. So why is this sort of statistic not well know?

There can be no greater motivation to recover than knowing that the vast majority of people who do engage in treatment do actually recover! 

I recently came across an excellent article on this by Dr. Omar Manejwala,  former Medical Director for Hazelden Foundation, one of the nations oldest and largest addiction centers in the US.

I will quote from his blog here.

“…the recent tragic overdose death of Phillip Seymour Hoffman, whom many have noted was reportedly abstinent from alcohol and drugs for over two decades, raises another set of important questions:

  • Do people who get sober actually stay sober?

  • Can’t you ever be free of addiction? Are you always at risk of relapse?

  • Is there some period when, like cancer, you are considered to be “cured”?

  • Isn’t staying sober for a long time at least somewhat protective?

In my experience treating thousands of addicts, I’ve learned that cases like these can often diminish hope and create a perception that these conditions aren’t treatable, or that addicts can never be trusted.

When is an addict or alcoholic sober long enough to be considered at least relatively safe? Do most people with addiction who have been sober a long time eventually relapse?  In scientific terms, what is the natural history of recovery from alcohol and drug addiction?

I’ve seen numerous experts speak up in the wake of Hoffman’s death, but few have offered hard science on what we really know about how a person’s duration of sobriety is related to their chances of being sober in the subsequent years. Fortunately, there are data to support the idea that recovery is durable, and that the vast majority of people who stay sober for a long time will continue to stay sober afterwards.

The most thorough attempt to understand what happens to addicts and alcoholics who stay sober is an eight-year study of nearly 1200 addicts. They were able to follow up on over 94% of the study participants, and they found that extended abstinence really does predict long term recovery. Some takeaways from this research are:

  • Only about a third of people who are abstinent less than a year will remain abstinent.

  • For those who achieve a year of sobriety, less than half will relapse.

  • If you can make it to 5 years of sobriety, your chance of relapse is less than 15 percent.

 

Of course, there are many people with 10, 20, 30 or even 40 years of abstinence…. My experience is that people with decades of abstinence clearly can and do relapse, but the incidence is very low. Like Hoffman and many others, it’s always heartbreaking when it happens. I’ve seen it triggered by opiate prescriptions, acute pain and other life stressors. Often the people who relapse have stopped engaging in the recovery-oriented practices that served them well during their earlier sobriety.

Every death from addiction is tragic. But cases like Hoffman’s are definitely the exception and not the rule.”

Copyright Omar Manejwala, M.D. 2013.

 

 

 

Link/reference

http://www.manejwala.com/#!single-post/cyqt/1

Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.

Do people recover without treatment?

I want to comment on an article I read recently which stated some FACTS 1. about  3/4 of individuals in recovery did not use formal treatment or mutual help groups to achieve full, sustained remission. 2.  About 20% of all people with alcohol use disorders recover naturally, without formal treatment or mutual help. Individuals with less severe substance use problems, fewer psychiatric comorbidities and more recovery capital (e.g. social support) have a greater chance of recovering without formal treatment. 4. Self-efficacy, or one’s level of belief in the chances of success is an important predictor of natural recovery success.

http://www.recoveryanswers.org/recovery/natural-recovery/

First of all, it is never a good way to start an article by stating you have FACTS, not good practice. Given this article appeared in a website which I think is great and does good work and has good contributors I was surprised by the claims of this article, which I believe are dangerously misleading to those who actually suffer from alcoholism and are being directed to go it alone. Which of the hundreds of alcoholics I have known over many years, including myself, has not once tried that approach!

This article may be confusing abuse with addiction, they are transitory phases in the addiction cycle, one less severe than the other, so it may be easier to get off the train earlier than later with addiction, if you have no underlying conditions.  

Equally the sample population for studies of this kind often contains people are not actually alcoholic but simply drink too much. Alcholism is more than alcohol. Alcoholism is an underlying psychiatric condition maladaptively treated by alcohol. 

Alcoholism is on a spectrum of severity, with various underlying psychiatric complications. 

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This article is misleading as it then states in it’s “facts” that “individuals who did not utilize formal help or treatment in their recovery process were more likely to have non-abstinent recoveries compared to individuals who did engage in formal substance use help and/or treatment” These so-called non-abstinent recoveries are not recoveries then!

One study (1) examined the rates and predictors of 3-year remission, and subsequent 16-year relapse, among initially untreated individuals with alcohol use disorders who did not obtain help or who participated in treatment and/or Alcoholics Anonymous in the first year after recognizing their need for help. A sample of individuals (n = 461) who initiated help-seeking was surveyed at baseline and 1 year, 3 years, 8 years and 16 years later.

Compared to individuals who obtained help, those who did not were less likely to achieve 3-year remission and subsequently were more likely to relapse.  Among individuals who were remitted (relapsed) at 3 years, those who consumed more alcohol but were less likely to see their drinking as a significant problem, had less self-efficacy, and relied more on avoidance coping, were more likely to relapse by 16 years.

Conclusion – Natural remission may be followed by a high likelihood of relapse; thus, preventive interventions may be indicated to forestall future alcohol problems among individuals who stop or  cut down on their own.

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Chronic alcoholism is a condition of severely limited self will or cognitive control over addictive behaviours, as a result we, as recovering alcoholics, need the help of others to act as our external prefrontal cortex, our external cognitive control over subcortical addictive behaviour and our evident emotional dysregulation, until we can do it ourselves more effectively.

I do not remember having a choice in getting off my train earlier, it never occurred to me even as my illness kept the truth about what I had from me. Like many alcoholics I was the last to know.
AA came into being to help those who cannot recover by themselves – like me and countless others who tried but failed. Read The Natural History of Alcoholism by George Vaillant who, over many decades, showed clearly the progression of this disease/disorder, many of his extensive sample also thought they could go it alone, only to find they ultimately needed help or died from their alcoholism. Alcoholism is a fatal condition if left untreated. Sometimes I wish academics who write about it, would consider this when they write about it too.

http://www.amazon.com/The-Natural-History-Alcoholism-Revisited/dp/0674603788

 

References

1. Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction101(2), 212-222.